瑞士多发性硬化症从首次出现症状到诊断及开始治疗的时间相关因素。
Factors associated with time from first-symptoms to diagnosis and treatment initiation of Multiple Sclerosis in Switzerland.
作者信息
Kaufmann Marco, Kuhle Jens, Puhan Milo A, Kamm Christian P, Chan Andrew, Salmen Anke, Kesselring Jürg, Calabrese Pasquale, Gobbi Claudio, Pot Caroline, Steinemann Nina, Rodgers Stephanie, von Wyl Viktor
机构信息
Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland.
Neurologic Clinic and Policlinic, University Hospital and University of Basel, Switzerland.
出版信息
Mult Scler J Exp Transl Clin. 2018 Dec 6;4(4):2055217318814562. doi: 10.1177/2055217318814562. eCollection 2018 Oct-Dec.
BACKGROUND
Recent studies emphasise the importance of timely diagnosis and early initiation of disease-modifying treatment in the long-term prognosis of multiple sclerosis.
OBJECTIVES
The objective of this study was to investigate factors associated with extended time to diagnosis and time to disease-modifying treatment initiation in the Swiss Multiple Sclerosis Registry.
METHODS
We used retrospective data (diagnoses 1996-2017) of the survey-based Swiss Multiple Sclerosis Registry and fitted logistic regression models (extended time to diagnosis ≥2 years from first symptoms, extended time to disease-modifying treatment initiation ≥1 year from diagnosis) with demographic and a priori defined variables.
RESULTS
Our study, based on 996 persons with multiple sclerosis, suggests that 40% had an extended time to diagnosis, and extended time to disease-modifying treatment initiation was seen in 23%. Factors associated with extended time to diagnosis were primary progressive multiple sclerosis (odds ratio (OR) 5.09 (3.12-8.49)), diagnosis setting outside of hospital (neurologist (private practice) OR 1.54 (1.16-2.05)) and more uncommon first symptoms (per additional symptom OR 1.17 (1.06-1.30)). Older age at onset (per additional 5 years OR 0.84 (0.78-0.90)) and gait problems (OR 0.65 (0.47-0.89)) or paresthesia (OR 0.72 (0.54-0.95)) as first symptoms were associated with shorter time to diagnosis. Extended time to disease-modifying treatment initiation was associated with older age at diagnosis (per additional 5 years OR 1.18 (1.09-1.29)). In more recent years, time to diagnosis and time to disease-modifying treatment initiation tended to be shorter.
CONCLUSIONS
Even in recent periods, substantial and partially systematic variation regarding time to diagnosis and time to disease-modifying treatment initiation remains. With the emerging paradigm of early treatment, the residual variation should be monitored carefully.
背景
近期研究强调了及时诊断和尽早开始疾病修正治疗对多发性硬化症长期预后的重要性。
目的
本研究的目的是调查瑞士多发性硬化症登记处中与诊断延迟时间延长以及疾病修正治疗开始时间延长相关的因素。
方法
我们使用了基于调查的瑞士多发性硬化症登记处的回顾性数据（1996 - 2017年诊断病例），并采用逻辑回归模型（从首次出现症状起诊断延迟时间≥2年，从诊断起疾病修正治疗开始延迟时间≥1年），纳入人口统计学变量和预先定义的变量。
结果
我们对996例多发性硬化症患者的研究表明，40%的患者诊断延迟时间延长，23%的患者疾病修正治疗开始延迟时间延长。与诊断延迟时间延长相关的因素包括原发进展型多发性硬化症（优势比（OR）5.09（3.12 - 8.49））、院外诊断环境（神经科医生（私人诊所）OR 1.54（1.16 - 2.05））以及更不常见的首发症状（每增加一种症状OR 1.17（1.06 - 1.30））。发病年龄较大（每增加5岁OR 0.84（0.78 - 0.90））以及首发症状为步态问题（OR 0.65（0.47 - 0.89））或感觉异常（OR 0.72（0.54 - 0.95））与诊断时间较短相关。疾病修正治疗开始延迟时间延长与诊断时年龄较大（每增加5岁OR 1.18（1.09 - 1.29））相关。近年来，诊断时间和疾病修正治疗开始时间趋于缩短。
结论
即使在近期，诊断时间和疾病修正治疗开始时间仍存在显著且部分为系统性的差异。随着早期治疗模式的出现，应仔细监测残留差异。
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